The overall objective of this application is to build capacity in longitudinal survey research methods and investigate the burden of dementia and related personal, social and health challenges in the older population of Lebanon. Population aging is occurring across the entire world, including in many low- and middle-income countries (LMIC). As a result, these countries face a rapidly growing burden of common age-associated chronic illnesses, including Alzheimer's disease and related dementias (ADRD). Lebanon is a middle-income country in the Middle East North Africa (MENA) region where the prevalence of ADRD is estimated to be among the highest in the world. There is currently very limited reliable information on the prevalence and incidence of ADRD and on the primary ADRD risk factors in this population. Furthermore, LMIC countries like Lebanon often face substantial challenges in the adequate provision of care for ADRD, and very little is known about patterns of formal and informal care for the health and personal needs of affected older adults and their families. There is also insufficient research capacity for the conduct of rigorous studies of ADRD to address the population burden due to ADRD in Lebanon. The proposed project has two over-arching goals. First, it aims to build new research capacity for the conduct of rigorous epidemiological studies of ADRD and other important aging-related health and social outcomes, with particular emphasis on longitudinal research designs and complex sampling strategies. The research capacity activities will be developed and carried out in close collaboration between the investigative teams at the American University of Beirut (AUB) and the University of Michigan, involving a series of training modules that are relevant to the social and cultural context in Lebanon. Second, it aims to develop a new population-based cohort study and recruit a sample of 3,000 adults aged 60 and older who will participate in a structured assessment of dementia, caregiver needs and arrangements, and other health and social domains relevant to understanding the challenges of population aging in Lebanon. The study intends to generate important new information on novel risk factors for ADRD, especially as it relates to the role of prolonged exposure to stressful social conditions throughout the lifecourse. Large segments of the adult population have experienced political instability and conflict that has dominated public life in Lebanon during the last four decades. It will also add important new information on caregiver needs and arrangements, especially as it relates to the growth in the hiring of domestic migrant workers. This model of care for older adults is increasingly replacing more traditional care models that rely on relatives. Findings from this work will not only inform potential strategies to reduce the population burden due to ADRD, but are also expected to increase our understanding of potentially important new risk factors for ADRD and the care arrangements for older adults with ADRD in many other settings and populations around the world.

Relevance As a result of population aging, many low- and middle-income countries such as Lebanon face a rapidly growing burden of dementia. This proposal represents a collaboration between the American University of Beirut and the University of Michigan to develop a program of research capacity building and a population- based study to identify important new risk factors for dementia in Lebanon as well as the caregiver needs and arrangements for older adults. Findings from this program are expected to have substantial relevance for a better understanding of dementia risks and associated care needs in Lebanon and other low-resource settings around the world.